Notices: 39th Annual Meeting of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition Dresden, Germany, June 7-10, 2006: Abstracts: PG1-15
Recent guidelines recommend screening for coeliac disease (CD) in Type I diabetes (DM) at diagnosis of DM and then 3 yearly. CD may be asymptomatic and intermediate benefits of a gluten free diet (GFD) are unknown.
1. To identify frequency of gastrointestinal (GI) symptoms in children with DM and screening detected CD and intermediate effect of GFD. 2. To compare GI symptoms with control children with coeliac serology negative DM.
Retrospective case note audit of serology of children with DM and screening detected CD. All were referred to a paediatric gastroenterologist from the diabetic team. GI symptoms were recorded.
Prevalence of biopsy confirmed CD in DM was 4.5 % (16 of 351). Median age of diagnosis of DM was 4 years (1.4 - 11.8) and CD was 9.5 years (4.2 - 16.6 yrs). One child was diagnosed with CD before the onset of DM and 1 had autoimmune thyroiditis. One or more GI symptoms were reported by 80% after GI assessment (12 of 15 children): abdominal pain (60%), change in bowel habit or diarrhoea (33%), distension/bloating (20%), reduced appetite (6%) and tiredness (13%). Suboptimal weight gain was documented in 26%. Symptoms resolved following introduction of a GFD. Improved mood was reported by 2 (13%) and improved concentration by 1 child. A significant improvement in weight (mean SDS 0.34, p = 0.009) and body mass index (mean SDS 0.45, p = 0.02) was noted in those compliant with GFD after one year. A significant increase (p = 0.017) in insulin requirement (mean increase 0.084 U/Kg) was also seen in those compliant with GFD. Specific GI questions were incorporated in the annual DM review. The frequency of GI symptoms in CD negative serology DM was 6% (1/16). (x2 corrected = 14.40, 1 df, p =.0001).
Children with DM and screening detected CD have a higher prevalence of GI symptoms than their CD-serology negative DM peers, and inadequate weight gain may be demonstrable. Institution of a GFD has a positive effect on nutritional status in the short term. Targeted questions on GI symptoms at annual review might identify candidates for CD serology testing prior to 3yrs.